Provider Demographics
NPI:1114057916
Name:PONTARELLI, VITTORIA MADIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VITTORIA
Middle Name:MADIA
Last Name:PONTARELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 S SURREY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3560
Mailing Address - Country:US
Mailing Address - Phone:847-322-4341
Mailing Address - Fax:
Practice Address - Street 1:2334 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1948
Practice Address - Country:US
Practice Address - Phone:773-561-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice